Insurance Information

UPMC UCPA accepts the following insurance:

Aetna, Aetna Medicare, Advantra, Amerihealth Administrators, Blue Journey, Blue Shield, Capital Blue Cross, Cigna, Cigna Medicare, Coresource, First Health, FreedomBlue, Gateway Medicare Assured, Penn State Health Holy Spirit Health Plan, Penn State Health Holy Spirit Gold, Great West Health Plan, HealthAmerica, Humana Medicare PPO, Intergroup, Keystone, Loomis, Mailhandlers, Medicare, South Central Preferred, Teamsters, Tricare, United Healthcare, United Healthcare Medicare, UPMC Health Plan, and VibraHealth.

Health insurance is a contract between you and your insurance company that provides protection against medical costs. The amount of protection that it provides varies depending on the policy and provisions for each insurance company and what type of coverage you choose. There are various types of insurance available. The following is an example of those available:

A federal program that provides health insurance to retired individuals, regardless of their medical condition. Medicare Part B, also known as “medical insurance”, would cover services such as doctor’s office, outpatient services, laboratory tests, physical, speech, or occupational therapy, or an ambulance transport. Medicare Part A would be for hospital services or skilled nursing facilities and also would cover hospice and home health care.

This is a health insurance program designed for low-income people. It is a federal-state program that allows those who could not otherwise afford necessary medical care.

*HMO- HMO (Health maintenance organization)
Requires a primary care physician (PCP). You would need to contact your PCP first for all medical care needs. Before you would see a urologist or any specialist, you would need to consult with your PCP. HMO’s provide medical treatment on a prepaid basis. You will pay a fixed monthly fee, regardless of how much medical care is needed in a given month.

*PPO- PPO (Preferred provider organization)
This is similar to HMO in that they are both a managed healthcare. However, a PPO is a group of doctors and/or hospitals that provides medical service only to a group or association. PPO members pay for services as they are rendered. The member would pay his or her co-payment as outlined in their individual policy. You are not required to seek care from PPO physicians. However, if you were to see a PPO physician, your out of pocket expense may significantly be reduced.

*Group Health
Rather than covering just one person, a Group Health Insurance is a single policy that covers the medical expenses of many people. All eligible people can be covered by a group policy, regardless of age or physical condition. Premiums are based on several factors such as age and degree of occupational hazard.

*Individual Insurance
You would obtain this type of insurance, for example, if you were self-employed. This insurance covers medical expenses for one person or family. Typically, you would be required to take a physical exam and answer several medical questions. The insurance company that you have selected will then determine whether or not you would qualify and the premiums you would be required to pay.

Because it can be very confusing trying to understand the various insurance terminology here is a list of common insurance terms and their definitions:

Coinsurance – payment that a participant is required to make to a participating provider for covered services. Typically it is a percentage of the contracted reimbursement rate.

Copayment or Deductible – this is a payment that a participant is required to make to a provider. This is calculated as a fixed dollar amount, set by the insurance company.

EOB-explanation of benefits – This form is generated from the insurance company and will give detailed information regarding charges, payments and any adjustments for the services rendered. Also, will outline specifically what is due to the provider and what is the responsibility of the member.

My doctor has referred me to a urologist, what do I need to bring to my appointment? Always bring a listing of all your medications and the number of times and dosage you take daily. Read on for more of what to bring to your urological appointment:
•Referral – Because urology is a specialty practice, you may be required to obtain a referral. It is your responsibility to obtain this referral from your primary care physician and bring this with you to your appointment with the urologist. This referral is needed in order to obtain reimbursement from your insurance company.
•Insurance Card – We need to make a copy of the front and back of your insurance card. This is done so that when we file a claim to your insurance company, we will ensure that we have all the correct information specific to your coverage.
•Labs – If you have had lab work done, you may be instructed to bring information regarding your labs to the urologist.
•Patient Information Form – You may be given a patient information form to have completed prior to your visit with the urologist. Please complete this form and give to the doctors office when you check in.
•Insurance Benefits – It is strongly suggested that you verify coverage with your insurance company prior to your visit, if possible. It is your responsibility to make sure your visit will be covered. We will assist you if needed in order to verify benefits, but we cannot guarantee payment by your insurance company.